Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma

Abstract

Variable and total costs and length of stay were significantly lower in our population of patients who underwent DL as compared to NL. The rate of negative or nontherapeutic laparotomy was also significantly reduced when compared to the rate identified during the era prior to the use of laparoscopy. Laparoscopy resulted in an overall savings of $1,059 per laparoscopy performed when compared to laparotomy.

Laparoscopy in Acute Mesenteric Ischemia

“…After that term the conversion rate is similar to that of delayed surgery (38.9%) [40]. However it needs to be pointed out that even though one recent observational study confirmed these findings [46], others did not [47][48][49] and one of the systematic reviews examined above [43] performed a subgroup analysis comparing data from the trials which included only patients treated less than four days from the onset of symptoms to those of the studies also including patients with a longer delay, and could not demonstrate a statistically significant difference between the two groups. Further studies could clarify this issue.…”

“…Walsh et al [42] have proposed that when on laparoscopic exploration the perforation has been plugged, to leave the omentum in situ and only perform a simple cleaning of the abdominal cavity. As an alternative to classical suturing, several changes have been proposed to simplify the method: single-stitch laparoscopic repair [10]; use of a clip to tighten the suture (avoiding a knot in the suture) [43,44]; using an automated stapler [45] ( d stapled omental patch repair) [46]; reverting to laparoscopic-endoscopic (gastroscopy-aided repair) [47].…”

“…The introduction of drugs able to control hyperacidity and the radical treatment of HP made possible by antibiotics have led on the one hand to a reduced need for acid-reductive surgery and on the other hand a reduction of ulcerative recurrences (and so the need for re-intervention surgery) [43,44,59]. Nevertheless, up to 35% of patients who have undergone PPU may require definitive surgical treatment, which may be conducted laparoscopically in relation to the degree of the surgeon's skill, considering also the overlapping results which compare the open technique: recurrence of the ulcer from 4 to 11%; post-op complications 1-2% [12,13].…”

“…Another approach described in recent years is the endoscopic (transgastric or transduodenal) access for drainage/debridement of necrosis in carefully selected patients [42,43]. Recently the introduction of EUS guidance and Doppler imaging in order to avoid blood vessels has provided a safer approach.…”

“…In a retrospective analysis comparing the total hospital costs of exploratory laparotomy to those of diagnostic laparoscopy in 37 patients with penetrating abdominal trauma, the cost analysis showed that the laparoscopy-based strategy was about EUR 1,136 cheaper than the exploratory laparotomy based strategy (EL 3a) [43]. In a prospective, randomized study of 43 patients with abdominal stab wounds, however, there was no difference between the two strategies in the total hospital costs (EL 1b) [11].…”